Laparoscopic approaches to failed fundoplication for reflux

With laparoscopic primary fundoplication now a well-established treatment for gastroesophageal reflux disease (GERD), there is an increasing number of patients that are being referred for complex reoperative intervention for failed primary fundoplication. The majority of patients presenting with failed primary fundoplication can be managed non-operatively, a subset of patients will benefit from re-operative surgery. Re-operative anti-reflux surgery can usually be performed using minimally invasive techniques with good results. The key principle of re-operative surgery for failed fundoplication is establishing and restoration of normal anatomy. It is also essential to perform complete mediastinal esophageal mobilization to recognize a short esophagus, and to preserve crural integrity. The surgical options for an anti-reflux procedure include redo-fundoplication, and Roux-en-Y near esophagojejunostomy (RNYNEJ). In some instances, esophagectomy may be indicated.